NPI | 1154960813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008502) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2019-12-29 |
Last Update Date | 2021-12-08 |